QALY denying access to cancer drugs: study

Patients in countries whose healthcare systems’ reimbursement decisions consider how much a cancer treatment costs per quality-adjusted life year achieved (CPQ) have less access to new cancer drugs than those in countries which do not use CPQ, according to a new study.

Also, fewer new cancer drugs are reimbursed in CPQ countries than in non-CPQ countries, their reimbursement decisions take longer and, historically, they have adopted new cancer drugs more slowly and, in the long term, at lower rates in CPQ countries, says the study, from the IMS Institute for Healthcare Informatics.

The study compared the reimbursement for nine new cancer drugs and 11 new non-cancer treatments in five CPQ countries – Australia, Canada, England, Scotland and Sweden – and five non-CPQ drugs – France, Germany, Italy, Spain and the US.

It found that while most countries in both groups reimburse the majority of the non-cancer drugs and that all non-CPQ countries reimburse all nine cancer drugs - except for GlaxoSmithKline’s Arzerra (ofatumumab) in Spain - four of the five CPQ countries deny reimbursement for at least three of the cancer treatments.

For both cancer and non-cancer drugs, the median time between marketing approval and reimbursement decision is significantly longer in CPQ countries, it goes on, although pointing out that the automatic reimbursement for drugs in the US and Germany upon regulatory approval accounts for a large part of the difference.

Moreover, the adoption of modern cancer drugs starts later in CPQ countries and may never reach the levels seen in non-CPQ countries, although access to new non-cancer drugs is comparable across all 10 nations, it says.

CPQ analyses are subject to many uncertainties and inconsistencies, and the varying methodologies used can lead to widely varying reimbursement decisions. The use of different thresholds of cost-effectiveness introduces further variation; for example, England, Scotland and Australia use stricter thresholds, and therefore allowed less access to new cancer drugs, than Sweden and Canada, says IMS.

The study concludes that, across the 10 countries studied, drug spend per new cancer patient is consistently lower in CPQ than in non-CPQ countries, and lowest in the UK. Although lower drug spend may seem a benefit for healthcare systems, it may reflect costs of its own - across the 10 countries, cancer drug spending levels are roughly correlated with survival rates, and UK cancer survival rates are in the low end overall, and are also among the lowest in four of six common cancers.

These differences may arise from a combination of factors, including stage at diagnosis, time to referral to a specialist and effectiveness of surgical and other interventions, says IMS. However, it adds, the association with levels of cancer drug spending remains.